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Background: Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged ≥65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2535 patients, 558 (22.0 %) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9 % of patients were on guideline-adherent thromboprophylaxis, 6.8 % were overtreated, and 52.3 % were undertreated. Logistic analysis showed that increasing age (p = 0.01), heart failure (p = 0.04), coronary artery disease (p = 0.013), peripheral arterial disease (p = 0.03) and concomitant cancer (p = 0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p = 0.001) and cancer (p < 0.001), and inversely associated with HF (p = 0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p = 0.007) and CV death (p = 0.024) compared to those non-adherent. Kaplan–Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p = 0.002) and CV deaths (p = 0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p = 0.019 and p = 0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients.
Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation : insights from the REPOSI study
A. Nobili;V. Raparelli;L. Napoleone;P..M. Mannucci;G. Y. H. Lip;L. Pasina;C. Franchi;M. Marcucci;T. K. Eldin;M. P. D. Di Blanca;F. Perticone;S. Corrao;D. Prisco;E. Silvestri;C. Cenci;G. Emmi;G. Biolo;G. Guarnieri;M. Zanetti;G. Fernandes;M. Vanoli;G. Grignani;G. Casella;M. Bernardi;S. L. Bassi;L. Santi;G. Zaccherini;E. Mannarino;G. Lupattelli;V. Bianconi;F. Paciullo;R. Nuti;R. Valenti;M. Ruvio;S. Cappelli;A. Palazzuoli;T. Salvatore;F. C. Sasso;D. Girelli;O. Olivieri;T. Matteazzi;M. Barbagallo;L. Plances;R. Alcamo;G. Licata;L. Calvo;M. Valenti;M. Zoli;R. Arnò;F. L. Pasini;P. L. Capecchi;M. Bicchi;G. Palasciano;M. E. Modeo;M. Peragine;F. Pappagallo;DI GENNARO, ROBERTA CARMELA;A. Postiglione;M. R. Barbella;F. De Stefano;CAPPELLINI;MARIA DOMENICA;G. Fabio;SEGHEZZI, SONIA;M. M. De Amicis;D. Mari;P. D. Rossi;B. B. Ottolini;S. Pugliese;M..V. Lenti;D. Padula;G. Murialdo;A. Marra;F. Cattaneo;M. B. Secchi;D. Ghelfi;L. Anastasio;L. Sofia;M. Carbone;G. Davì;M. T. Guagnano;S. Sestili;G. Mancuso;D. Calipari;M. Bartone;M. R. Meroni;P. C. Perin;B. Lorenzati;G. Gruden;G. Bruno;C. Amione;P. Fornengo;R. Tassara;D. Melis;L. Rebella;V. Pretti;M. S. Masala;L. Bolondi;L. Rasciti;I. Serio;F. R. Fanelli;A. Amoroso;A. Molfino;E. Petrillo;G. Zuccalà;F. Franceschi;G. De Marco;C. Chiara;S. Marta;G. Romanelli;G. Delitala;D. Chiesa;A. Picardi;U. V. Gentilucci;P. Gallo;G. Annoni;M. Corsi;S. Zazzetta;G. Bellelli;F. Arturi;E. Succurro;M. Rubino;G. Sesti;P. Loria;M. A. Becchi;G. Martucci;A. Fantuzzi;M. Maurantonio;S. Carta;S. Atzori;M. G. Serra;M. A. Bleve;L. Gasbarrone;M. R. Sajeva;A. Brucato;S. Ghidoni;P. Di Corato;G. Agnelli;E. Marchesini;F. Fabris;M. Carlon;A. Baritusso;R. Manfredini;C. Molino;M. Pala;F. Fabbian;B. Boari;A. De Giorgi;G. Paolisso;M. R. Rizzo;M. T. Laieta;G. Rini;P. Mansueto;I. Pepe;C. Borghi;E. Strocchi;V. De Sando;C. Sabbà;F. S. Vella;P. Suppressa;R. Valerio;C. Capobianco;L. Fenoglio;C. Bracco;A. V. Giraudo;E. Testa;C. Serraino;S. Fargion;P. Bonara;G. Periti;M. Porzio;F. Peyvandi;A. Tedeschi;R. Rossio;V. Monzani;V. Savojardo;C. Folli;M. Magnini;GOBBO, GIULIA MARIA LETIZIA;C. L. Balduini;G. Bertolino;S. Provini;F. Quaglia;F. Dallegri;L. Ottonello;L. Liberale;W. S. Chin;L. Carassale;S. Caporotundo;G. Traisci;L. De Feudis;S. Di Carlo;N. L. Liberato;A. Buratti;T. Tognin;G. B. Bianchi;S. Giaquinto;F. Purrello;A. Di Pino;S. Piro;R. Rozzini;L. Falanga;G. Montrucchio;E. Greco;P. Tizzani;P. Petitti;A. Perciccante;A. Coralli;R. Salmi;P. Gaudenzi;S. Gamberini;A. Semplicini;L. Gottardo;G. Vendemiale;G. Serviddio;R. Forlano;C. Masala;A. Mammarella;S. Basili;L. Perri;R. Landolfi;M. Montalto;A. Mirijello;C. Vallone;M. Bellusci;D. Setti;F. Pedrazzoli;L. Guasti;L. Castiglioni;A. Maresca;A. Squizzato;M. Molaro;M. Bertolotti;C. Mussi;M. V. Libbra;A. Miceli;E. Pellegrini;L. Carulli;A. Sciacqua;M. Quero;C. Bagnato;R. Corinaldesi;R. De Giorgio;M. Serra;V. Grasso;E. Ruggeri;A. Salvi;R. Leonardi;C. Grassini;I. Mascherona;G. Minelli;F. Maltese;A. Gabrielli;M. Mattioli;W. Capeci;G. P. Martino;S. Messina;R. Ghio;S. Favorini;A. D. Col;S. Minisola;L. Colangelo;A. Afeltra;P. Alemanno;B. Marigliano;P. Castellino;J. Blanco;L. Zanoli;M. Cattaneo;P. Fracasso;M. V. Amoruso;V. Saracco;M. Fogliati;C. Bussolino;V. Durante;G. Eusebi;D. Tirotta;F. Mete;M. Gino;A. Cittadini;M. Arcopinto;A. Salzano;E. Bobbio;A. M. Marra;D. Sirico;G. Moreo;F. Scopelliti;F. Gasparini;M. Cocca;R. D. Nieves;M. M. Alberto;A. R. Pedro;L. P. Vanessa;T. Lara;C. V. Xavier;F. Francesc;D. M. Jesus;B. T. Esperanza;D. C. Behamonte Esther;S. P. Maria;M. Romero;P. L. Blanca;L. G. Cristina;V. G. M. Victoria;L. Saez;J. Bosco;S. B. Susana;A. G. Marta;G. B. Concepcion;F. M. Antonio;M. G. Hernandez;M. P. Borrego;P. C. Raquel;P. R. Florencia;G. O. Beatriz;C. G. Sara;G. Cervellera Alfonso;P. M. Marta;R. C. Alberto;A. A. Antonio;G. G. Montserrat;B. R. Miguel Ángel;M. J. Manuel;N. V. Ignacio;A. S. Lucía;L. Alfonso;R. B. David;I. V. Iria;R. P. Monica;F. Salerno;PROIETTI, MARCO
2016-01-01
Abstract
Background: Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged ≥65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2535 patients, 558 (22.0 %) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9 % of patients were on guideline-adherent thromboprophylaxis, 6.8 % were overtreated, and 52.3 % were undertreated. Logistic analysis showed that increasing age (p = 0.01), heart failure (p = 0.04), coronary artery disease (p = 0.013), peripheral arterial disease (p = 0.03) and concomitant cancer (p = 0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p = 0.001) and cancer (p < 0.001), and inversely associated with HF (p = 0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p = 0.007) and CV death (p = 0.024) compared to those non-adherent. Kaplan–Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p = 0.002) and CV deaths (p = 0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p = 0.019 and p = 0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients.
Antithrombotic therapy Atrial fibrillation Elderly Guidelines Outcomes Age Factors Aged Aged 80 and over Atrial Fibrillation Chi-Square Distribution Female Fibrinolytic Agents Guideline Adherence Humans Italy Kaplan-Meier Estimate Logistic Models Male Practice Patterns Physicians' Proportional Hazards Models Registries Risk Assessment Risk Factors Thromboembolism Time Factors Treatment Outcome Practice Guidelines as Topic Cardiology and Cardiovascular Medicine
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/82898
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
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